EmailMe Form - APPLICATION for Professional Vehicle Operator

Name

First Middle Last

Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Physical Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Email

Is any additional information relative to change of name, use of assumed name, or nickname necessary to enable a check on the information you are providing on this application?

Yes

No

If so please explain:

Do you have a driver’s license now?

Yes

No

Liscense Info State:

License Number:

Class:

Expriation Date:

Class:

If you were in the U.S. Armed Forces, please indicate Branch:

Do you need a reasonable accommodation to take an interview or written test?

Yes

No

Were you ever discharged, released during probation or for unfavorable circumstances from any employment?

Yes

No

If yes, please explain:

EDUCATION: Check the highest grade of school completed:

Provide the information listed below about any college or university you have attended and/or any business, trade,
service, or correspondence school:
Name of Institution

Address

Course of Study

Duration

List any degrees, awards, certifications, special training you have had:

List computer programs, systems in which you are proficient:

If you speak any languages other than English, please list:

Starting with your most recent employment, provide a complete record of all employment during the past 10 years. Explain any gaps in employment. A resume may be attached but cannot be used as a substitute for the
following

Dates of Employment

Job Title & Duties:

Employer/Address/Phone:

Reason for Leaving:

Dates of Employment

Job Title & Duties:

Dates of Employment

Reason for Leaving:

ESTA operates nearly every day of the year. Our service day begins as early as 6:00am and ends at 2:00am for
specific routes. Your work assignments may be adjusted based upon the needs of the Agency. Please indicate
which days you are available to work. Mark all that apply:

Indicate how many hours you would like to work each week:

Less than 20

At Least 20

At Least 32

Are you willing and able to work regularly six days a week?

Yes

No

Are you willing and able to work overtime with little notice?

Yes

No

What is the earliest time you are willing and able to work?

What is the latest time you are willing and able to work?

I agree and understand that any misrepresentation of information or omissions of facts I have provided in this application for employment are grounds for immediate discharge.

I agree and understand that representatives of ESTA may investigate my background to ascertain and obtain any and all information of concern to my record, whether same is of record or not, including without limitation matters of public record. “Public records” are defined as “records documenting an arrest, indictment, conviction, civil judicial action, tax lien, or outstanding judgment”. I understand and agree that I have a right to receive a copy of public record information directly obtained by ESTA. I understand and agree that I will not receive a copy of such public record information if I check the box below waiving my right to such information. I release ESTA, its employees and all persons from any liability for furnishing such information.

I waive my right to a copy of public record information obtained by ESTA

Yes

No

I agree and understand that this Application for Employment in no way obligates ESTA to employ me.

Offers of employment for Vehicle Operators or any Safety Sensitive positions are conditional and contingent on the successful completion of a pre-employment drug test and a post job offer physical, and in certain instances a fingerprint clearance and background investigation.

I, hereby agree and understand that, as part of my application for employment for a position which involves the performance of safety-sensitive functions as defined by 49 CFR Part 655, as amended, I must submit to a urine drug test as required by the U.S. Department of Transportation, Federal Transit Administration. I acknowledge and understand that my employment is contingent on the passing of the aforementioned drug test, and I will not be
assigned to perform a safety-sensitive function unless my urine drug test has a verified negative result.

I certify that this application for Employment was completed by me, and that all entries on it and information in it and any attachments signed by me are true and correct to the best of my knowledge.

Signature (sign with mouse or finger)

Clear

EQUAL OPPORTUNITY-AFFIRMATIVE ACTION EMPLOYER-

Please help us comply with the State & Federal law by completing this section. While you are not required to complete this section, you should know that if you leave it blank we have the right to enter data for this purpose based upon our visual assessment. To demonstrate that we meet the equal employment opportunity requirements, periodically we must report statistical information about applicants & employees to the State & Federal Governments. This information will be kept confidential & will not be used in any unlawful way to make any employment decision. ESTA is an Affirmative Action Employer.

Name of Applicant:

Date:

Title of Position Applied For:

Date of Birth:

Male

Female

Nonbinary

CONFIDENTIAL SAFETY-SENSITIVE EMPLOYEE APPLICATION SUPPLEMENT
Previous US Department of Transportation Drug and Alcohol Testing

Name

First MI Last

Have you ever participated in USDOT-regulated drug and alcohol testing with previous employers?

Yes (if yes, complete #1 and #2)

No (if no, skip to #2)

1. In the last two years, have you ever:
a. Tested positive (0.04 or greater) for alcohol?

Yes

No

b. Had a verified positive drug test result?

Yes

No

c. Refused a required drug or alcohol test (or had a verified adulterated or substituted drug test result)?

Yes

No

d. Violated any other DOT drug or alcohol testing regulation within the last two years?

Yes

No

2. Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules in the last two years?

Yes

No

if you responded YES to any of the above questions, please provide documentation or your successful completion pf DOT return-to-duty requirements. If you do not have this information please expoanin why:

I certify that the facts contained in this form are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this form shall be grounds for dismissal.

Signature

Clear

Date:

Upload your driving record here. Or you may email it to dvidal@estransit.com. You can find your drifving record at https://www.dmv.ca.gov/portal/customer-service/request-vehicle-or-driver-records/online-driver-record-request/